A solution for accurate documentation during vacuum-assisted delivery

December 2005

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Clinical experience over the past decade has confirmed that vacuum-assisted delivery is a safe and effective operative vaginal delivery method. In fact, since 1992, the number of vacuum-assisted deliveries has increasingly outpaced the number of forceps deliveries¹. Device design, cup placement and proper delivery technique have proven to be the key components in conducting a safe and successful vacuum delivery.

 Although vacuum-assisted delivery can produce positive outcomes in indicated operative delivery cases, some physicians still exhibit a hesitancy to fully embrace the potential benefit of this method. Part of this hesitation may be due to the lack of training and education afforded operative vaginal delivery, resulting in fewer and fewer physicians being trained in proper vacuum technique. Another may be patient resistance to the procedure. Yet another may be the physician’s fear of litigation in complicated operative delivery cases.²

 The passage of time and increased exposure to vacuum-assisted delivery and its benefits has contributed to greater acceptance of this procedure. Training resources are becoming more readily available, procedures more commonplace, and clinical and public confidence in vacuum-assisted delivery is growing.

Technology advances will also play a vital role in the increasing acceptance of vacuum as a viable operative delivery option. By putting more information in the hands of the physician for educated clinical decisions, new vacuum technology will help develop an increased

familiarity and comfort level. One such technological advance (VacuLink™, Medevco, Inc., Dallas, TX) is a device that measures and records clinical vacuum values during a vacuum-assisted delivery. This device connects the handheld vacuum device to the bedside maternal/fetal monitor (see Figure A) to perform real-time recordings (see Figure B) of the following values:

1. Maximum vacuum achieved

2. Cumulative time at maximum vacuum

3. Total time of vacuum application

4. Number of pulls

5. Number of involuntary releases (pop-offs)

6. Reduction of vacuum between contractions

This real-time information has significant value for the management of clinical decisions during a vacuum-assisted delivery. Physicians familiar with clinical studies that detail safe vacuum levels^3,4; proper procedure duration^5,6; reasons for pop-offs⁷, corrective measures⁸ and maximum number of  reapplications^9,10; and deliberate retention or reduction of vacuum levels^11,12,13 will have information at their fingertips that will confirm proper vacuum technique 

or warn of potential red flags. Not only can this information lead to more positive outcomes, but it could also greatly reduce legal exposure on the part of the physician. And because it is documented in real-time, post-procedure paperwork is simplified and more accurate.

The VacuLink™ system consists of the recording device, a segment of sterile plastic tubing and a reusable cable (see Figure C). The cable connects to the Uterine Activity (U/A) or Toco port on the maternal/fetal monitor, and connects into the recording device. One end of the sterile tubing is attached to the vacuum device and the other is attached using the luer-lock connector on the vacuum device. Both the Kiwi OmniCup^® (VAC-7000M) and ProCup^® (VAC-7000S) have been modified with the luer-lock connector for compatibility with this device).

Historically, documentation of the vacuum-assisted delivery was not completed until after the delivery was concluded, and a vacuum tracing was not available for analysis during the delivery. With this recording device, physicians will have real-time, electronic documentation of the procedure and will be able to communicate progress, recognize limitations, and plan for alternatives when necessary. As this and other technology continues to be

Footnotes:

¹Vacuum-assisted delivery: a review. R.W. McQuivey. The Journal of Maternal-Fetal and Neonatal Medicine 2004; 16: 171-179.

² Preserving the Option of Vacuum Extraction: 5 Experts Tell Why. OBG Management. February 2004; 46-60.

³ Vacca A: Handbook of Vacuum Extraction in Obstetric Practice. Brisbane, Australia. Vacca Research Pty. Ltd.  1999, 19-21.

⁴ Chez, Bofill, Morrison. Performing vacuum-assisted vaginal delivery, clinical dialogue. Contemporary Ob/Gyn,  Nov. 1998: 63.

⁵ Vacca A, Operative Techniques. Current Obstet. & Gynecol. 1999; 44.

⁶ Chez, Bofill, Morrison. Performing vacuum-assisted vaginal delivery, clinical dialogue. Contemporary Ob/Gyn,  Nov. 1998: 64.

⁷ Vacca A: Handbook of Vacuum Extraction in Obstetric Practice. Brisbane, Australia. Vacca Research Pty. Ltd.  1999, 19-21.

⁸ Vacca A, Operative Techniques. Current Obstet. & Gynecol. 1999; vol 9, page 44.

⁹ Panel of Experts, Brumfield, Gilstrap III, O’Grady, Ross, Shcifrin. Cutting your legal risks VE, OBG
   Management, March 1999, page 32.

¹⁰ Chez, Bofill, Morrison. Performing vacuum-assisted vaginal delivery, Clinical Dialogue. Contemporary Ob/Gyn, Nov. 1998: 67.

¹¹ Vacca A: Handbook of Vacuum Extraction in Obstetric Practice. Brisbane, Australia. Vacca Research Pty. Ltd. 1999, 19-21.

¹² Chez, Bofill, Morrison. Performing vacuum-assisted vaginal delivery, clinical dialogue. Contemporary Ob/Gyn, Nov. 1998: 63-64.

¹³ Bofill, et al. A randomized trial of two vacuum extraction techniques. Ob/Gyn 1997: 89, 758-762.